Addressing the Adverse Family Physical Environment: A Systematic Review of Interventions

Background and Purposes: Adverse family physical environments, such as household chaos, crowding, noise, deterioration, household hazards, and limited safety or hygiene resources, are increasingly recognized as critical yet underaddressed determinants of health. Prior research suggests that these unfavorable family conditions are associated with negative outcomes for children and families. Although a growing number of interventions aim to improve aspects of the family physical environment, the evidence remains fragmented across disciplines and intervention types. The systematic review aimed to: (1) synthesize the existing evidence on interventions addressing adverse family physical environments; (2) assess their effects on physical environment improvement, parenting and family functioning, and related parent and child outcomes; (3) identify gaps in research and practice to guide future intervention development and implementation.

Methods: Guided by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), we conducted a systematic review of peer-reviewed studies examining interventions that explicitly or implicitly targeted improvement in the family physical environment. Six databases were searched: Web of Science Core Collection, Social Services Abstracts, PsycINFO, PubMed, CINAHL, and Embase. Google Scholar and reference check were used as complementary search strategies. The search yielded 8927 records. Three independent reviewers screened the studies. After removing duplicates, title and abstract screening, and full-text review, 20 studies were identified for this review, based on the following inclusion criteria: (1) peer-reviewed empirical studies; (2) published in English language; (3) interventions addressed domains such as household chaos, crowding, noise, hygiene, toxins/hazards, or other housing-related adverse conditions; and (4) studies reported at least one outcome related to changes in family physical environment, parenting/family functioning, parent health, or child health.

Results: The 20 included studies were conducted across diverse countries and populations and used randomized controlled trials, quasi-experimental designs, and program evaluations. Interventions varied considerably in focus, including home visiting, behavioral counseling, environmental modification, parent training, and multicomponent family support programs. Overall, findings suggest that interventions directly targeting the family physical environment were associated with improvements in specific home conditions, such as reduced household chaos, improved safety, healthier routines, and better hygiene or environmental health practices. Several studies also reported positive effects on parenting, caregiver knowledge and behaviors, and selected child health or developmental outcomes. However, findings were mixed across intervention types, and some studies showed limited or no significant effects. The evidence base was also heterogeneous in conceptualization, measurement, and outcome reporting.

Conclusions and Implications: This review suggests that adverse family physical environments are modifiable intervention targets and that improving these conditions may benefit both parents and children. At the same time, the literature remains limited by inconsistency in definitions, measures, and intervention scope. More rigorous and theory-informed research is needed to identify which components are most effective, for whom, and under what conditions. Future social work research and practice should more explicitly address the family physical environment as an important context that shapes parenting quality, family functioning, and parent and child well-being.